In the eight states that expanded Medicaid after 2018, the number of people receiving prescriptions for the opioid addiction treatment medication buprenorphine increased dramatically, according to a paper that researchers will present next month.
The states that expanded Medicaid before that period also saw gains, but they were generally smaller. That’s because other changes, aside from Medicaid expansion, made buprenorphine easier to get after 2018.
The researchers found that among all patients — those covered by Medicaid, other insurers and the uninsured — the number of buprenorphine prescriptions increased in the eight most recent Medicaid expansion states (Idaho, Maine, Missouri, North Carolina, Oklahoma, South Dakota, Utah and Virginia) by more than 21% between 2019 and 2023. Maine, Oklahoma and Virginia saw the most dramatic increases.
Among the states that expanded Medicaid in 2018 or before, Kentucky, Vermont and West Virginia experienced the largest boosts. The study, published in February in JAMA Network Open, was conducted by researchers from Rutgers University and Indiana University, based on pharmacy claims data from retailers across the country.
Stephen Crystal, director of the Center for Health Services Research at Rutgers University and one of the authors, explained that buprenorphine became more accessible after 2018 as the federal government loosened various prescribing rules, including allowing prescribing via telehealth.
“Longer-term tracking shows that expansion, whether early or later, provides essential financial access and supports the growth of a provider network that improves population-level treatment rates,” Crystal told Stateline.
Experts warn that looming Medicaid cuts could cut off buprenorphine access to thousands of patients. The broad tax and spending law President Donald Trump signed last summer is projected to cut federal Medicaid spending by an estimated $886.8 billion over the next decade, largely because new work requirements will push people off the rolls, according to estimates by the Congressional Budget Office. CBO estimates that it could increase the number of people without health insurance by 7.5 million in 2034.
Opioid overdose deaths in the U.S. peaked during the COVID-19 pandemic, reaching a high of 81,806 deaths in 2022. They’ve fallen sharply since then, to 79,358 in 2023 and 54,045 in 2024.
Medicaid is the largest payer of opioid use disorder treatment, and in 2023 it covered nearly half of all non-elderly adults in the U.S. with opioid use disorder in 2023, said Robin Rudowitz, a senior vice president at KFF, a health policy research group.
“Having health insurance is the main way for people to have consistent access to health care services, and also particularly for Medicaid, as most people are low income, and it provides protections against financial burdens,” Rudowitz said.
“And for (opioid use disorder) specifically, research shows that when people discontinue treatment, mortality risk increases. And for discontinuation of Medicaid, specifically, when coverage lapses, mortality rate increases.”
Stateline reporter Shalina Chatlani can be reached at schatlani@stateline.org.
This story was originally produced by Stateline, which is part of States Newsroom, a nonprofit news network which includes NC Newsline, and is supported by grants and a coalition of donors as a 501c(3) public charity.
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